CMS Clears Up Uncertainty Regarding TPOC Reporting Threshold: $2,000 Threshold Remains in Place

Last week, CMS announced an "increase" in the $300 threshold below which claims do not have to be reported to Medicare and for which Medicare will not seek recovery of conditional payments.  That threshold was changed from $300 to $1,000 and was effective immediately with the publishing of the alert.  Given the wording of the CMS alert, it remained unclear, however, whether the $2,000 TPOC reporting threshold currently in place until October, 2014 was also changed.

Today, CMS issued an updated version of the NGHP User Guide which clarified the issue.  The new threshold does NOT affect the current $2,000 TPOC threshold.  The User Guide now provides as follows: 

• If the most recent TPOC Date is on or between October 1, 2013 and September 30, 2014, and the cumulative TPOC Amount is greater than $2,000, the TPOC(s) must be reported no later than the end of the RRE’s submission timeframe in the quarter beginning January 1, 2014.
•  For this date range, TPOCs greater than $300 through $2,000 may be reported, but there is no requirement to do so.
• If an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error. 
• If the most recent TPOC Date is on or after October 1, 2014, and the cumulative TPOC Amount is greater than $1000, the TPOC(s) must be reported no later than the end of the RRE’s submission timeframe in the quarter beginning January 1, 2015.
•  For this date range, TPOCs greater than $300 through $1,000 may be reported, but there is no requirement to do so. 
• If an add record is submitted for this date range with a total TPOC Amount less than or equal to $300, the claim report will reject with a CJ07 error.

The NGHP User Guide may be found by clicking here.